Peripheral control device for simulating endoscopy procedures

ABSTRACT

A portable peripheral control device for simulating endoscopy procedures, configured for being connected to a computer, includes a mounting element and a control lever, constrained to the mounting element, reproducing a handgrip of a flexible endoscope for medical use. The control lever has a plurality of actuators replicating corresponding actuators presented by the handgrip of the flexible endoscope for medical use. The peripheral control device includes a movement device configured for simulating a movement of a tubular element of a flexible endoscope and is configured for converting at least one actuation of the control lever into an electrical signal signifying the actuation. The peripheral control device is configured for converting an activation of the actuators into an electrical signal signifying the activation, for converting a movement of the movement device into an electrical signal signifying the movement. The peripheral control device includes at least one output for the electrical signals.

TECHNICAL FIELD

This invention relates to a peripheral control device for simulating endoscopy procedures and in particular a portable peripheral control device for an endoscopy simulator.

BACKGROUND ART

This invention relates to a peripheral control device for simulating endoscopy procedures and in particular a portable peripheral control device for an endoscopy simulator.

The peripheral device inserts in the field of systems for learning endoscopic procedures which can also be defined as simulators.

The traditional concept of teaching endoscopy comprises the direct interaction between the student, such as a medical student, and the teacher, that is to say, the reference doctor, during an endoscopic examination performed on the patient to be treated, that is to say, one on one training.

The method allows a more effective learning for the student of the endoscopy procedures but, however, with several drawbacks such as, for example, an increase in the time needed for the performance of the examination, with possible complications, and discomfort for the patient, with consequent increase in the overall costs to be borne by the hospital.

In order to overcome the above-mentioned drawbacks, endoscopic simulators have been developed which allow the students di carry out le endoscopic procedures in a controlled environment, without risks for the patients, allowing the student to train in endoscopy procedures in order to acquire the correct sensitivity in order to proceed onto patients.

Currently, four types of endoscopic simulators are substantially known: mechanical simulators, animal models, live or dead, computerised models and composite simulators, that is to say, mechanical models which have inherent animals parts, with or without the presence of electronic computers.

Only endoscopic simulators validated by clinical studies are currently present on the market.

The models which use live animals have in fact been abolished, since they caused unnecessary physical and psychological suffering for the animal, and they have been superseded by composite models which use mechanical parts assembled with organs which are no longer alive.

For example, some simulators have a part which faithfully replicates a human bust inside of which are housed organs derived from live animals. These composite models can be used to simulate a large range of medical procedures, such as gastroscopy, colonoscopy, haemostasis techniques, endoscopic mucosal and sub-mucosal resection, endoscopic retrograde cholangio-pancreatography, echo-endoscopy, enteroscopy with double balloon, percutaneous gastrostomy and others.

Although very effective, the composite models are very expensive, not very flexible, require a constant replacement of the organic parts and leave little room for errors.

The purely mechanical models, that is to say, without the use of organic part coming from live animals, overcome some of the above-mentioned drawbacks of the composite endoscopic models, but do not provide the same realism as the other models.

The computerised models, which allow particularly realistic simulations, were introduced for the first time in the 1980s.

Sine then, with the increasing development of electronic and information technology, these simulators have undergone an enormous technological development.

The advanced technology allows these simulators to use graphical endoscopic images displayed on the screen on the basis of the task of the student or on the basis of the difficulty of the procedure to be performed.

The learning procedures can comprise movements of the accessories in real time and increasing difficulty with various scenarios.

There are prior art computerised simulators consisting of an integrated and autonomous console, equipped with screens and operating system.

These simulators faithfully imitate the shape and the structure of an endoscope and the physical response of the body in which it is inserted, thanks to the feedback control. Some known simulators use actual endoscopes for medical use for their operation.

Disadvantageously, the known computerised endoscopic simulators, whilst being very faithful, are very complex, bulky, not easy to move and expensive, which are all features which have an adverse effect on the wide scale diffusion and the possibility of use by students outside hospital environments.

Moreover, the integration in the simulator of the processing units and of the control software makes it difficult to carry out any connections to the Internet and provide updates and use digital teaching platforms which are accessible online. These drawbacks limit the real possibilities of access by the students to the endoscopic simulators present in hospital facilities, which is incompatible with the teaching requirements to be provided to the students.

It has also been found that, during the teaching of novice students, the physical faithfulness of the known simulators to the real endoscopic devices is too accurate for the novice students.

AIM OF THE INVENTION

In this context, one aspect of this invention is to provide a portable peripheral control device for simulating endoscopy procedures configured to be connected to a computer and which comprises a mounting element and a control lever, constrained to the mounting element, reproducing a handgrip of a flexible endoscope for medical use; the control lever has a plurality of actuation devices replicating corresponding actuating means presented by the handgrip of the flexible endoscope for medical use.

The peripheral control device being configured for converting at least one actuation of the control lever into an electrical signal signifying the actuation.

The peripheral control device is configured for converting at least one activation of the actuating means into an electrical signal signifying the activation.

The peripheral control device is being configured for converting a movement of the movement device into an electrical signal signifying the movement.

The peripheral control device comprises at least one output for the electrical signals.

According to an aspect of the invention, the peripheral device comprises a plurality of connectors for making available these outputs.

Advantageously, the peripheral control device structured in this way allows students to perform endoscopic simulation exercises in any environment, even in a domestic environment, at least for acquiring a basic dexterity, and it is easily portable, as it has reduced dimensions and weight.

According to an aspect of the invention, the invention relates to a the simulator for endoscopy which comprises a peripheral control device according to one of the aspects indicated and a computer connected to the peripheral control device.

Advantageously, the peripheral control device according to the invention is an inexpensive simulator compared with the known simulators and consequently accessible to a vast number of users.

BRIEF DESCRIPTION OF THE DRAWINGS

Further features and advantages of this invention are more apparent from the non-limiting description which follows of a preferred, non-limiting embodiment of a peripheral control device for simulating endoscopy procedures, as illustrated in the accompanying drawings, in which:

FIG. 1 is a schematic perspective view of a peripheral control device for simulating endoscopy procedures made according to this invention;

FIG. 2 is a further schematic perspective view of the peripheral control device of FIG. 1 , with some parts cut away in order to better illustrate others;

FIG. 3 is a schematic cross-sectional view of a detail of the peripheral control device of FIG. 1 ;

FIG. 4 illustrates a second embodiment of the detail of FIG. 3 ;

FIG. 5 illustrates a variant of the second embodiment of the detail of FIG. 4 ;

FIG. 6 illustrates a third embodiment of the detail of FIG. 3 ;

FIG. 7 illustrates a variant of the third embodiment of FIG. 6 ;

FIG. 8 illustrates a fourth embodiment of the detail of FIG. 3 ;

FIG. 9 illustrates a variant of the fourth embodiment of the detail of FIG. 8 ;

FIG. 10 shows a schematic representation of the peripheral control device according to this invention;

FIG. 11 shows a further variant of FIG. 1 .

DETAILED DESCRIPTION OF PREFERRED EMBODIMENTS OF THE INVENTION

With reference to the accompanying drawings, the numeral 1 generically denotes a portable peripheral control device for simulating endoscopic procedures.

The term “portable” means that the peripheral device 1 can be carried, can easily be moved and transported from one place to another, or does not require a fixed installation so can be used in any location where, as described in more detail below, it may be connected to a suitably programmed or programmable computer.

The peripheral control device 1 is configured to be connected to a computer “C”.

In some embodiments the connection to the computer “C” is performed by a physical connection, for example a cable for transferring data, preferably USB type, and the peripheral control device 1 is configured for being connected to the above-mentioned cable.

According to alternative embodiments, the connection is carried out using a wireless data connection, such as, for example, WI-FI® or Bluetooth®, and the peripheral control device 1 comprises devices configured to establish a wireless data connection.

The peripheral control device 1 according to this invention comprises a control lever 6 configured to reproduce a handle or handgrip of a flexible endoscope for medical use equipped with respective actuating means 8 a, 8 b, 8 c, 8 d, 9, “a”, 8 e, 8 f.

The control lever 6 is connected to a respective mounting element 2.

The mounting element 2 defines a supporting base which is stable during the handling of the control lever 6.

The mounting element 2 has one or more suction cups 2 a to allow the anchoring on a supporting surface.

The control lever 6 is connected to the mounting element 2 by a hinge 7. In the preferred embodiment, the hinge 7 allows rotations of the control lever 6 about its axis of rotation “A1” and variations of inclination of the axis of rotation “A1” relative to the mounting element 2.

In at least one particular embodiment, the hinge 7 comprises an elastic joint 7 a, preferably consisting of an elastic element, and a spherical coupling 7 b.

The elastic joint 7 a preferably consists of an elastic clip with a length of less than 5 cm.

The aim of the elastic joint 7 a is to increase the freedom of movement of the control lever 6 for better simulating the movement of the handle of a flexible endoscope for medical use.

The control lever 6 comprises directional handles 8 a configured for simulating the rotation of the tip of the endoscope and an element 8 b for locking the positioning of the directional handles 8 a.

The control lever 6 comprises one or more activating elements 8 c configured for simulating the action of a blowing/washing valve and a suction valve 8 c.

The control lever 6 has a channel 9 configured for receiving a bar “a”.

The channel 9 is configured for simulating a proximal portion of an operating channel inside an endoscope for medical use, for example, the bioptic channel or the channel of the instruments, which are often coincident.

The channel 9 is designed to receive the bar “a” for simulating accessory devices of an endoscope for medical use.

The control lever 6 comprises one or more accessory pushbuttons 8 d for simulating the selection of the accessory and simulating the actions on the accessory itself.

These actions can be combined with the advance of the bar “a” in the channel 9.

The control lever 6 comprises one or more elements 8 f for activating accessory activities, such as, for example, washing, current supply etc.

The control lever 6 comprises a regulator 8 e for simulating the rigidity of the structure of the endoscope.

The directional handles 8 a, the element 8 b for locking the positioning of the directional handles 8 a, the activating elements 8 c, the channel 9 configured to receive a bar “a”, the accessory pushbuttons 8 d, the activating elements 8 f and the regulator 8 e define the above-mentioned actuating devices of the lever 6.

The peripheral control device 1 is configured for converting the movements of the control lever 6 relative to the mounting element 2 into first electrical signals “Si” and for transmitting them to the computer “C”.

The peripheral control device 1 comprises an outlet, schematically represented as a block 31, for the signals “s1”, which can therefore be transmitted to the above-mentioned computer “C”.

More specifically, the movements of the control lever 6 transformed into electrical signals “s1” comprise the rotations of the control lever 6 about its longitudinal axis “A1” and the variations of inclination of the longitudinal axis “A1”.

The peripheral control device 1 is configured for converting the movements of the control lever 6 into electrical signals “s2” and for transmitting them to the computer “C”.

The peripheral device 1 comprises an outlet, schematically represented as a block 32, for the signals “s2”, which can therefore be transmitted to the above-mentioned computer “C”.

Movements on the control lever 6 means the movements carried out by a user by means of the above-mentioned movement means 8 a, 8 b 8 c, 8 d, 9, “a”, 8 e, 8 f.

More specifically, with reference to the above, the peripheral control device 1 is configured for converting the movement of the bar “a” in the channel 9, the rotation of the directional handles 8 a, the movement of the locking element 8 b, the activation of the movement pushbuttons 8 c, the activation of the accessory pushbuttons 8 d, the activating elements 8 f and the regulator 8 e, into electrical signals “s2”.

The peripheral control device is configured to detect the presence of the bar “a” in the channel 9 and convert a first actuation of the bar “a” in the channel 9 in a first electrical signal “s2”.

The peripheral control device 1 is configured for converting an actuation of the directional knob and/or of the locking element 8 b into a second electrical signal “s2”.

The peripheral control device 1 is configured for converting an actuation of the activating element 8 f into a third electrical signal “s2”.

The peripheral control device 1 is configured for converting an actuation of the regulator 8 e into a fourth electrical signal “s2”.

According to this invention, the peripheral control device 1 comprises a movement device 10 configured for simulating the functions and the physical behaviour of the tubular part of the endoscope for medical use.

The peripheral control device 1 is configured for converting movements of the movement device 10 into electrical signals s3 and transmitting them to the computer “C”.

The movement device 10 comprises a main element 11 and a main supporting body 3 of the main element 11.

The element 11 replicates, as will be clarified, a flexible element of a real endoscope; in that sense, the element 11 is also referred to as a tubular element since the real endoscopy is hollow inside.

The supporting body 3 has a supporting base 5 preferably comprising a plurality of suction cups 5 a for anchoring the supporting body 3 on a supporting surface.

It should be noted that in an embodiment illustrated, the supporting element 3 of the control lever 6 and the supporting body 3 of the movement device 10 define a single body 4.

Alternatively, the supporting element 3 of the control lever 6 and the supporting body 3 of the movement device 10 are different from each other and physically separate.

According to this configuration, it is possible to anchor the supporting element 3 of the control lever 6 and the supporting body 3 of the movement device 10 on respective resting planes and at a distance determined by the user.

It should be noted, however, that, regardless of whether the supporting element 3 of the control lever 6 and the supporting body 3 of the movement device 10 are physically connected or separate, the computer “C” is configured to simultaneously process the electrical signals generated by the control lever 6 and by the movement device 10 for simulating the correct operation of an endoscope.

The term computer “C” is used to mean any computer, such as a personal computer, which able to process these signals “s1”, “s2”, “s3”.

The processing may be carried out by means of software resident in the computer or also online according to known techniques.

Various embodiments of the shape of the movement device 10 are described below.

In general, the tubular element 11 is equipped with a main longitudinal axis of extension “A2”, relative to its transversal extension.

According to the embodiments illustrated in FIGS. 1 to 7 , the tubular element 11 is flexible since it is configured to undergo a bending of 180° along its main axis of extension “A2”, without breaking or plastic deformation.

Preferably, according to these embodiments, the tubular element 11 is made of elastomeric material.

In its preferred embodiment, the tubular element 11 has mechanical characteristics replicating the tubular part of a flexible endoscope for medical use.

As may be inferred from drawings, at least part of the tubular element 11 is positioned inside the supporting body 3 and at least a part of it is positioned outside it.

According to the embodiments illustrated in FIGS. 1 to 8 , the tubular element 11 can be moved, manually by a user, inside and outside the supporting body 3, along a direction parallel to its axis of extension “A2” (translation “T”), and can rotate about its main axis of extension “A2” (rotation “R”), simulating the movements which can be carried out by a doctor by means of the tubular part of an endoscope.

For this purpose, it has, located on an outer portion of the tubular element 11, a gripping surface 12, which favours the gripping of the tubular element 11 by the user to perform the movement along its main axis of extension “A2” or around it.

In the embodiments of FIGS. 1, 4, 6 and 7 , the gripping surface 12 coincides with the outer surface of the tubular element 11.

In the embodiments of FIGS. 5 and 8 , the movement device 10 comprises a handle 16, having the gripping surface 12 for moving the flexible element 11.

According to the first embodiment illustrated in FIGS. 1 to 3 and 11 , the tubular element 11 is a closed element, without free ends.

In other words, the tubular element 11 defines a closed path.

In other words, with reference to FIGS. 1 to 3 , the tubular element 11 is ring-shaped.

With reference to FIG. 12 , the tubular element 11 has a figure-of-eight shape.

Alternatively, the tubular element 11 can have any shape providing it is a closed element.

According to this variant embodiment, at least part of the tubular element 3 is housed inside the box-shaped body 3.

More specifically, the supporting body 3 has two holes 14, each for a respective branch of the tubular element 11, for allowing the passage between the inside and outside of the supporting body 3.

Still more specifically, the supporting body 3 has two holes 14 for the passage of the tubular element 11, one upper and one lower relative to the supporting base 5.

This embodiment substantially reduces the overall dimensions and allows a substantial structural simplification with respect to the classic configuration wherein the tubular part of an endoscope is an element with a length of approximately 2 metres.

In effect, thanks to its closed shape, the tubular element 11 can slide indefinitely inside the supporting body 3 without ever reaching the end stop.

In order to allow the movement of the tubular element 11 inside and outside the supporting body 3, the supporting body 3 comprises a drum 15 rotatable about its own axis of rotation 15 a.

The rotatable drum 15 has an outer surface which can be coupled to a portion of the tubular element 11 which is positioned on it, following the curvature.

Advantageously, the rotation of the rotatable drum 15, about its own axis of rotation 15 a, is constrained to the translation “T” of the tubular element 11 along its main axis of extension “A2” and is therefore a measurement of the above-mentioned translation.

The peripheral control device 1 comprises a first sensor 13 a of rotation of the tubular element 11 about its main axis of extension “A2”.

The first rotation sensor 13 a is located inside the supporting body 3 and engages a portion of the tubular element 3.

The peripheral control device 1 comprises a second sensor 13 b configured for measuring the translation “T” of the tubular element 11 along its main axis of extension “A2”, preferably by the measurement of the rotation of the rotatable drum 15.

In a variant of the first embodiment, illustrated in FIG. 4 , the peripheral control device 1 has all the features described above and a second rotatable drum 15 b, positioned inside the supporting body 3, which can be coupled to a portion of the tubular element 11 which is positioned on it, following the curvature.

The two rotatable drums 15 and 15 a keep the tubular element 11 under tension.

Advantageously, the tubular element 11 is preloaded and is not subject to compression instability.

A third embodiment, illustrated in FIG. 5 , is similar to the second solution described above.

Unlike the second solution, the movement device 10 comprises a handle 16, having the gripping surface 12 for moving the flexible element 11.

The handle 16 can be coupled to the tubular element 11 and is connected to it in such a way that a translation of the handle 16 is constrained to the translation “T” of the tubular element 11 along its main axis of extension “A2”.

In this embodiment, the handle 16 allows enables the rotation of the tubular element 11 about its main axis of extension “A2”.

Alternatively, the handle 16 is rotationally movable (rotation “R”) about the axis of extension “A2”, as in the embodiments of FIGS. 8 and 9 . In this case, the first sensor 13 a for measuring the above-mentioned rotation is positioned inside of the handle 16.

The embodiments, illustrated in FIGS. 6, 7 and 8 , differ from the first in that the tubular element 11 has respective free ends at the two ends. This variant is without the rotatable drum 15, 15 b.

According to this embodiment, the supporting body 3 has a single passage hole 14 for the single delivery of the tubular element 11 inside the supporting body 3.

According to this solution, in order to measure the translation “T” of the tubular element 11 along its main axis of extension “A2”, the peripheral control device 1 comprises a second sensor 13 b located inside the box-shaped body 3 which engages a respective portion of the tubular element 11.

The fourth embodiment has two variants, a “long” one and a “short” one. In the “long” variant, illustrated in FIG. 6 , the tubular element 11 is of a length comparable to that of the tubular part of an endoscope for medical use.

Preferably, the supporting body 3 has a rear passage 14 a for the escape of an end portion of the tubular element 11. In the “short” variant, illustrated in FIG. 7 , the tubular element 11 has a length substantially less than that of the tubular part of a gastric endoscope.

According to this variant, the supporting body 3 is free of the rear passage 14 a for the escape of an end portion of the tubular element 11.

A fifth embodiment, illustrated in FIG. 8 , can be likened to the “short” variant described above, with the difference that the tubular element 11 consists of a rigid rod, preferably with a length substantially less than that of the tubular part of an endoscope for medical use. The above-mentioned rod is rigid inasmuch that it does not undergo appreciable deformations under force conditions which are created in a normal endoscopic simulation.

In this fifth solution the supporting body 3 comprises inside it a guide 20 shaped to match the tubular element 11 to allow the translation “T” and/or the rotation “R”.

In a sixth embodiment, illustrated in FIG. 9 , the supporting body 3 comprises a supporting bar 3 a, rigid and integral with it, preferably with a length substantially less than that of the tubular part of an endoscope for medical use.

According to this embodiment, the movement device 10 consists of a body having an inner coupling surface shaped to match an outer surface of the supporting bar 3 a.

The movement device 10 also has an outer surface defining the gripping surface 12.

The gripping surface 12 is defined by a knob 16.

According to this variant embodiment, the handle 16 is mounted on the supporting bar 3 a and is slidably movable along a longitudinal axis “A2” (translation “T”).

Preferably, the handle 16 is rotationally movable about the above-mentioned longitudinal axis “A2” (rotation “R”).

In this embodiment, the handle 16 comprises the first sensor 13 a for measuring the rotation “R” of the movement device 10 around the supporting bar 3 a and the second sensor 13 b for measuring the translation “T” of the movement device 10 along the supporting bar 3 a. Advantageously, in all the embodiments described above, the peripheral control device 1 is configured to detect and/or measure movements of the movement device 10 and convert them into electrical signals “s3” and transmit them to the computer “C”.

The first sensor 13 a is configured for converting the rotation of the gripping surface 12 into a first electrical signal “s3”.

The second sensor 13 b is configured for converting the translation of the gripping surface 12 into a second electrical signal “s3”.

More specifically, it measures the translation “T” which can be carried out by a manual force exerted on the gripping surface 12 along an axis of translation, preferably coinciding with the main axis of extension “A2” of the tubular element 11, by means of the second sensor 13 b.

Similarly, the peripheral control device 1 measures the rotation “R” which can be actuated by a manual twisting applied on the gripping surface 12 about the above-mentioned axis of translation by means of the first sensor 13 a.

Preferably, the peripheral control device 1 according to the embodiments illustrated comprises feedback devices 17 configured to apply a response force to a manual movement of the flexible element 11. The above-mentioned response force simulates, in use, a physiological response to the insertion of an endoscope for medical use in an organism.

According to the embodiments wherein the tubular element 11 is shorter than the tubular part of an endoscope for medical use, or in any case the maximum range of the movement device 10 is less than the necessary, the peripheral device 1 comprises a suspension control 18, preferably positioned on the gripping surface 12.

The suspension control 18 can preferably suspension be operated manually by the user.

Advantageously, it is configured for temporarily suspending the feedback forces on the flexible element 11.

It also makes it possible to modify the electrical signals “s3” in such a way that the computer “C” can ignore any movement of the movement device 10 performed whilst the suspension control 18 is activated.

The purpose of the suspension control 18 is to allow a withdrawal of the flexible element 11 if this has reached the end.

The computer “C” is configured to provide, using display means connected thereto, the response generated by the processing of the electrical signals it has received.

The computer “C” is configured to be connected into the Internet by means of a data connection.

The invention achieves the set aim by overcoming the disadvantages of the prior art.

In fact, the peripheral control device 1, effectively simulates the mechanics of an endoscope for medical use and is therefore suitable for basic level teaching. At the same time, thanks to the structural reconfiguration with respect t the known simulators, is it is considerably less expensive, compact and portable.

In effect, the peripheral control device 1 as such has a low cost and is simple in its architecture.

The outlets 31, 32, 33 make it possible to connect the peripheral device 1 to a any external calculator “C” which will be made able to process the signals s1, s2, s3 coming out of the peripheral device 1.

In FIG. 10 the numeral 100 denotes a simulator for endoscopy according to this invention.

The simulator 100 comprises a portable peripheral control device 1 and the computer “C”.

The computer “C” is configured to simultaneously process the electrical signals “s1”, “s2”, “s3” generated by the control lever 6 and by the movement device 10 and simulate the operation of a real endoscope.

As illustrated, by way of example, the computer “C” comprises a plurality of inputs C1, C2, C3 for connection to the outputs 31, 32, 33, according to, for example, the methods mentioned above.

In one embodiment, the simulator 100 comprises a simulation software resident in the computer C.

In one embodiment, the operation of the computer C is subject to a relative online connectivity, for example thanks to a simulation software which is accessible online.

Such a simulator is “portable” since, in practice, the peripheral device 1 can be easily transported and connected to any computer or PC.

This invention therefore provides a peripheral control device simulating endoscopic procedure suitable for a wide scale diffusion and home learning. Moreover, thanks to its connectivity, this invention can be efficiently used for connection to any personal computer, this aspect facilitating software updating and allowing an online platform to be created for teaching use of the endoscope, with, if necessary, tutorials and evaluation systems, and therefore reducing the time which skilled surgeons must dedicate to the basic teaching.

Unlike known simulators, the peripheral device and the calculating capacity of the computer are not integrated into a single instrument but are separate from each other, giving the user the possibility of connecting the peripheral control device to the most convenient or preferred computer. More specifically, the peripheral device is portable can be used in each desired circumstance or location. 

The invention claimed is:
 1. A portable peripheral control device (1), for simulating endoscopy procedures, comprising: a mounting element (2); a control lever (6), constrained to the mounting element (2) and reproducing a handgrip of a flexible endoscope for medical use, the control lever (6) having a plurality of actuators (8 a, 8 b 8 c, 8 d, 9, a, 8 e, 8 f) replicating corresponding actuators presented by the handgrip of the flexible endoscope for medical use, a movement device (10), separated from the control lever (6), configured for simulating a movement of a tubular element of a flexible endoscope; the peripheral control device (1) being configured to convert: at least one actuation of the control lever (6) into a first electrical signal (s1) signifying the actuation, at least one activation of the actuators (8 a, 8 b 8 c, 8 d, 9, a, 8 e, 8 f) into a second electrical signal (s2) signifying the activation, a movement of the movement device (10) into a third electrical signal (s3) signifying the movement, the peripheral control device comprising at least one output (31, 32, 33) for said first, second and third electrical signals (s1, s2, s3), wherein the movement device (10) comprises a supporting body (3) and a main element (11) connected to the supporting body (3); the movement device (10) having a gripping surface (12) by which to simulate movement of a tubular element of the flexible endoscope; the gripping surface (12) being part of the main element (11) or being movable relative to the main element (11), wherein the actuators comprise a channel (9) and a bar which can be inserted into the channel, the channel (9) replicating a proximal portion of an operating channel inside the flexible endoscope for medical use, the peripheral control device (1) being configured to detect the presence of the bar (a) in the channel (9) and convert a first actuation of the bar (a) in the channel (9) into the second electrical signal (s2).
 2. The portable peripheral control device (1) according to claim 1, wherein the control lever (6) is constrained to the mounting element (2) in such a way that variations of inclination of a relative longitudinal axis (A1) are allowed with respect to the mounting element (2) after the actuation.
 3. The portable peripheral control device (1) according to claim 1, wherein the control lever (6) is constrained to the mounting element (2) in such a way that rotations of the control lever (6) are allowed about a relative longitudinal axis (A1) after the actuation.
 4. The portable peripheral control device (1) according to claim 1, wherein the actuators comprise at least one accessory pushbutton (8 d) for selecting at least one method for conversion of the first actuation depending on the type of instrument simulated by the bar (a).
 5. A portable peripheral control device (1), for simulating endoscopy procedures, the portable peripheral control device comprising: a mounting element (2); a control lever (6), constrained to the mounting element (2) and reproducing a handgrip of a flexible endoscope for medical use, the control lever (6) having a plurality of actuators (8 a, 8 b 8 c, 8 d, 9, a, 8 e, 8 f) replicating corresponding actuators presented by the handgrip of the flexible endoscope for medical use, a movement device (10), separated from the control lever (6), configured for simulating a movement of a tubular element of a flexible endoscope; the peripheral control device (1) being configured to convert: at least one actuation of the control lever (6) into a first electrical signal (s1) signifying the actuation, at least one activation of the actuators (8 a, 8 b 8 c, 8 d, 9, a, 8 e, 8 f) into a second electrical signal (s2) signifying the activation, a movement of the movement device (10) into a third electrical signal (s3) signifying the movement, the peripheral control device further comprising at least one output (31, 32, 33) for said first, second and third electrical signals (s1, s2, s3), wherein the movement device (10) comprises a supporting body (3) and a main element (11) connected to the supporting body (3); the movement device (10) having a gripping surface (12) by which to simulate movement of a tubular element of the flexible endoscope; the gripping surface (12) being part of the main element (11) or being movable relative to the main element (11); wherein the actuators comprise at least one directional knob (8 a) configured to allow a simulation of a rotation of the tip of the flexible endoscope and a locking element (8 b) of the directional knob (8 a); the peripheral control device (1) being configured for converting an actuation of the directional knob and/or of the locking element (8 b) into a second electrical signal (s2).
 6. The portable peripheral control device (1) according to claim 1, wherein the actuators comprise at least one element (8 f) for activating accessory activities; the peripheral control device (1) being configured for converting an actuation of the activating element (8 f) into the second electrical signal (s2).
 7. The portable peripheral control device (1) according to claim 1, wherein the actuators comprise a regulator (8 e) for simulating the rigidity of the flexible endoscope; the peripheral control device (1) being configured for converting an actuation of the regulator (8 e) into a fourth electrical signal (s4).
 8. The portable peripheral control device (1) according to claim 1, wherein the gripping surface (12) is movable along an axis of translation to perform translations (T) as a function of a manual force exerted on the gripping surface (12), the movements of the movement device (10) comprising the translations (T) for simulating a translation of the tubular element of the flexible endoscope.
 9. The portable peripheral control device (1) according to claim 1, wherein the gripping surface (12) is rotatable about an axis of translation to perform rotations (R) as a function of a manual twisting applied to the gripping surface; the movements of the movement device (10) comprising the rotations (R) for simulating a rotation of the tubular element of the flexible endoscope.
 10. The portable peripheral control device (1) according to claim 1, comprising at least one feedback device (17) configured for applying a response force to a manual movement of the movement device (10), the response force simulating, in use, a physiological response to the insertion of an endoscope for medical use in an organism.
 11. The portable peripheral control device (1) according to claim 1, wherein the movement device (10) comprises a first sensor (13 a) for measuring a rotation (R) of the gripping surface (12); the first sensor (13 a) being configured for converting the rotation of the gripping surface (12) into said third electrical signal (s3).
 12. The portable peripheral control device (1) according to claim 1, wherein the movement device (10) comprises a second sensor (13 b) for measuring a translation of the gripping surface (12); the second sensor (13 b) being configured for converting the translation of the gripping surface (12) into said third electrical signal (s3).
 13. The portable peripheral control device (1) according to claim 1, wherein the main element (11) is partly enclosed by the supporting body (3), the supporting body (3) having at least one passage (14) for the main element (11).
 14. The portable peripheral control device (1) according to claim 13, wherein the main element (11) is flexible.
 15. The portable peripheral control device (1) according to claim 14, wherein the main element (11) is a closed element; the tubular element (11) defining a closed path.
 16. The portable peripheral control device (1) according to claim 1, further comprising a rotatable drum (15), the rotatable drum (15) having an outer surface which can be coupled to the main element (11), a rotation of the drum (15) being constrained to a translation (T) of the main element (11).
 17. The portable peripheral control device (1) according to claim 1, wherein the tubular element (11) is a rigid rod, the supporting body (3) comprising a longitudinal guide (20) shaped to match the rod rigid designed to allow the translation (T) of the rigid rod.
 18. The portable peripheral control device (1) according to claim 1, wherein the supporting body (3) comprises a supporting bar (3 a), the gripping surface (12) being movable on the supporting bar (3 a).
 19. A simulator for endoscopy comprising: a portable peripheral control device (1), for simulating endoscopy procedures, the portable peripheral control device comprising: a mounting element (2); a control lever (6), constrained to the mounting element (2) and reproducing a handgrip of a flexible endoscope for medical use, the control lever (6) having a plurality of actuators (8 a, 8 b 8 c, 8 d, 9, a, 8 e, 8 f) replicating corresponding actuators presented by the handgrip of the flexible endoscope for medical use, a movement device (10), separated from the control lever (6), configured for simulating a movement of a tubular element of a flexible endoscope; the peripheral control device (1) being configured to convert: at least one actuation of the control lever (6) into a first electrical signal (s1) signifying the actuation, at least one activation of the actuators (8 a, 8 b 8 c, 8 d, 9, a, 8 e, 8 f) into a second electrical signal (s2) signifying the activation, a movement of the movement device (10) into a third electrical signal (s3) signifying the movement, the peripheral control device further comprising at least one output (31, 32, 33) for said first, second and third electrical signals (s1, s2, s3), wherein the movement device (10) comprises a supporting body (3) and a main element (11) connected to the supporting body (3); the movement device (10) having a gripping surface (12) by which to simulate movement of a tubular element of the flexible endoscope; the gripping surface (12) being part of the main element (11) or being movable relative to the main element (11); and a computer (C) configured to simultaneously process said first, second and third electrical signals (s1, s2, s3) generated by the control lever (6) and by the movement device (10) and simulate the operation of an endoscope, the computer (C) comprising at least one input (C1, C2, C3) for a connection with the output (31, 32, 33).
 20. The simulator for endoscopy according to claim 19, comprising a simulation software resident in the computer (C).
 21. The simulator for endoscopy according to claim 19, comprising a simulation software accessible online by the computer (C).
 22. The simulator for endoscopy according to claim 19, wherein the computer (C) is configured to make available by display means connected thereto a response generated by processing said first, second and third electrical signals (s1, s2, s3). 